Get the free FMLA Medical Certification Form - Purdue University - purdue

Purdue University Human Resources Revised 7/13 PE RNR: Org. Unit: FMLA Medical Certification Form A complete medical certification is required to determine whether your health condition, or the health

How to fill out fmla medical certification form

How to fill out FMLA medical certification form:

1. Obtain the FMLA medical certification form from the human resources department or download it from the U.S. Department of Labor's website.
2. Read the instructions carefully to understand the purpose and the sections of the form.
3. Fill in the employee's personal information, such as name, employee ID, and contact details, in the designated fields.
4. Identify the type of FMLA leave being requested (e.g., serious health condition of the employee or a family member).
5. Provide the healthcare provider's contact information, including their name, address, and phone number.
6. Answer the relevant questions about the medical condition, including the duration or expected duration of the condition, and whether it requires continuous or intermittent leave.
7. If applicable, indicate if a second or third healthcare provider's opinion is necessary and provide the relevant details.
8. If the leave request is for a family member's serious health condition, provide the relationship of the employee to the family member and an explanation of how the employee's presence or care is required.
9. Have the healthcare provider complete the certification section, including their signature, date, and any additional comments or explanations.
10. Review the completed form for accuracy and completeness before submitting it to the human resources department.

Who needs FMLA medical certification form:

1. Employees who wish to take leave under the Family and Medical Leave Act (FMLA) may need to submit a medical certification form.
2. Employers may require employees to provide medical certification to verify the need for leave due to their own serious health condition or the serious health condition of a family member.
3. The FMLA medical certification form helps employers determine if the requested leave falls within the guidelines set by the FMLA and allows them to plan for the employee's absence and potential need for accommodations.

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What is fmla medical certification form?

FMLA medical certification form is a document that must be completed by a healthcare provider to certify the need for leave under the Family and Medical Leave Act (FMLA).

Who is required to file fmla medical certification form?

Employees who are requesting leave under the Family and Medical Leave Act (FMLA) are required to file the FMLA medical certification form.

How to fill out fmla medical certification form?

To fill out the FMLA medical certification form, a healthcare provider must provide details about the employee's medical condition, the need for leave, and the expected duration of the leave.

What is the purpose of fmla medical certification form?

The purpose of the FMLA medical certification form is to establish the need for leave under the Family and Medical Leave Act (FMLA) and to ensure that the employee is eligible for protected leave.

What information must be reported on fmla medical certification form?

The FMLA medical certification form must include information about the employee's medical condition, the need for leave, and the expected duration of the leave.